Articles Posted inWorkers’ Compensation Case Law

An issue that comes up in many Georgia workers’ compensation cases is whether an old injury that is aggravated while on the job qualifies for benefits. In a recent workers’ compensation case, one state’s supreme court found that a judge’s decision denying workers’ compensation benefits to an employee was supported by the evidence in a case involving multiple injuries.

The Facts of the Case

Before the employee began her job at a supermarket, she had broken her ankle. A few years after she began her job at the supermarket, she was diagnosed with post-traumatic arthritis in her ankle and was told to treat her ankle at home with a brace, supports, icing, stretching, and medication. Her job required her to stand for 40 to 45 hours per week. For the next 10 years, she sometimes felt minor pain and swelling in her ankle.

Then, while working, she tripped over a pallet and twisted her right ankle. About two days later, she sought medical treatment, and the doctor found her ankle was only mildly swollen and not bruised, but x-rays showed “degenerative changes.” The doctor determined she sprained her ankle, and she continued to work at the supermarket. The employee testified that her swelling and pain worsened continuously after the injury, but the doctor noted that the employee had decreased swelling and pain at the first follow-up appointment. At the next appointment about six weeks later, she said her ankle was “about the same,” but he recorded that she had improved slightly. The employee was doing physical therapy, but soon afterward, she twisted her ankle again. Her ankle did not get better, and the doctor scheduled her for an ankle-fusion surgery.

In a recent decision, a Georgia appeals court considered whether an employee who was injured while traveling from Georgia to Alabama for work was entitled to workers’ compensation benefits. The employee worked for a company repairing railroad tracks in different states. On one Sunday afternoon, the employee left his house in Georgia and drove toward Alabama, where he was supposed to begin work on a railroad track on the following morning. On his way to the motel, the employee was injured in a car accident. The employee filed for Georgia workers’ compensation benefits, claiming he was temporarily disabled. Yet the company argued that the accident did not arise out of and in the course of his employment.

What It Means to Arise Out of and in the Course of Employment

Under O.C.G.A. 34-9-1(4) of Georgia’s Workers’ Compensation Act, in order to be eligible for benefits, an injured employee must prove that their injury was related to their job. Specifically, an employee must show that the accidental injury arose out of and in the course of his or her employment. The requirement that the injury arises out of the employment means that there has to be a causal connection between the employee’s job and the injury. The requirement that the injury occurs in the course of employment considers the time, place, and circumstances of the injury.

Generally, injuries that occur when an employee is commuting to and from work do not arise out of and in the course of employment because courts believe that most jobs require some form of commute, which is not necessarily related to the functions of the job. In this case, the employee was traveling to a motel near the job site when the injury occurred. Accordingly, the court found the employee’s injury was not compensable.

Georgia workers’ compensation cases are often centered around the question of whether an employee’s injury was related to his employment. In some cases, injuries worsen over time, and an employee may need to seek additional compensation. However, employers often contest these claims. In a recent case, an appellate court considered whether a subsequent injury barred the employee from recovering workers’ compensation benefits for an earlier work-related injury. The employee had injured his back at work when he caught a falling ladder. He applied for workers’ compensation benefits and was awarded temporary total disability benefits and temporary partial disability benefits.

Later, the employee was injured outside work. The employee filed for benefits again, claiming that the second injury aggravated his existing injury. The workers’ compensation commission awarded him permanent partial disability benefits. The commission found his disability was partly caused by his work injury and partly due to pre-existing and subsequent conditions. Years later, the employee moved to reopen the case because he said his back condition had worsened. The case was reopened, but the commission found his second injury was a subsequent intervening event that broke the link between the work injury and his condition. The employee appealed the decision.

An appeals court explained that an award for temporary disability benefits considers the most recent injury, but an award for permanent disability benefits considers all of the injuries that caused the permanent disability. Therefore, the court determined that if an employee incurs an accidental injury and obtains workers’ compensation benefits, and then he incurs a subsequent intervening event, the intervening event does not preclude the employee from receiving additional permanent partial disability benefits for a decline in the employee’s condition. That is, even if there is a subsequent intervening event, the employee can still demonstrate that the employee’s condition has worsened and that the condition was caused by the work-related injury.

In a recent opinion, a state supreme court held that an employee could receive increased workers’ compensation benefits years after his accident, even after a doctor testified that the employee’s condition had not changed. The employee worked at a community organization and suffered a back injury at work in 2007 when his van was hit from behind. He returned to work, but in 2010, he had to stop working due to the pain from the injury. The employee filed for workers’ compensation benefits. The employer disputed the claim, arguing he was not impaired. In 2010, a judge awarded the employee permanent partial disability benefits and found he had a physical impairment rating of 13%.

In 2014, the employee claimed that his condition had worsened and requested to reopen his case. The employee introduced medical reports from two other doctors. One doctor found the employee had a 47% permanent impairment rating, and the other found he had a 28% permanent impairment rating. The employer also introduced a medical report from a doctor who found the employee had a 23% permanent impairment rating. The second judge found the employee had a physical impairment rating of 23%.

In a recent case, a Florida court of appeals recently considered whether one employee’s workers’ compensation claim was a result of a workplace injury or a result of a preexisting condition. The employee claimed that she injured her neck at work while pushing a passenger in a wheelchair. Her employer paid her workers’ compensation benefits and authorized an orthopedic surgeon to treat her injury.

However, the employer later claimed that the injury was not a result of a workplace injury but was due to a pre-existing condition. The orthopedic surgeon believed that the major contributing cause of the employee’s neck pain was not the workplace injury but instead was a preexisting degeneration of the cervical spine. An independent medical examiner also examined the employee and determined that the workplace injury was not a “major contributing cause” of her condition.

Under state law, an employer is responsible only if the workplace injury is the major contributing cause of any resulting injuries. That means that the workplace injury has to be more than 50% responsible for the employee’s injury. It also has to be demonstrated by objective medical evidence.

In a recent decision, a Florida court of appeals determined that a football player whose contract was not renewed for the following season and who then injured himself during tryouts was not entitled to workers’ compensation benefits despite a contract between him and the team. The court explained that although the team and the player had signed an employment contract that had not yet expired, the football league had never signed the contract.

The Facts of the Case

The football player had played for one year with the Orlando Predators, a team in the Arena Football League, but his contract was not renewed. He tried out again for the team, and on the second day of tryouts, he suffered an injury. He filed for workers’ compensation benefits, but the AFL contended they were not required to provide him with benefits.

The issue was whether the football player was an AFL “employee.” The football player argued he was entitled to benefits because he had signed a contract that stated that he was hired for employment from February to August of that year. He was injured at tryouts in July, one month before the contract ended. However, although the player and the team representative had signed the contract, the AFL never signed it.

In a recent case, an appellate court considered whether a woman had presented sufficient evidence to show she was entitled to home renovations after a workplace injury. The woman injured her lower back at work in 1989. In 2014, when the woman was in her 70s, she had a spinal fusion surgery and developed a difficulty in lifting the front part of her foot. She needed to use a cane and had difficulty maintaining her balance. She brought a workers’ compensation claim for the injury she sustained at work to authorize payment for her lawn care, attendant care, and treatment from a podiatrist, as well as home renovations.

To support her claim for home renovations, the woman hired a nurse to prepare a home assessment. The nurse made recommendations for home renovations, including a ramp, outdoor motion sensor lighting, and widened doors. The judge of compensation claims (JCC) awarded the woman all of the renovations recommended by the nurse, along with all of her other claims. The employer appealed the decision.

The state appellate court considered the award and affirmed the award for all of the services except for the home renovations. The appellate court determined there was not sufficient evidence to show that the home renovations were medically necessary. Under state law, the employer is required to provide compensation for treatment for injured workers, including any “medically necessary apparatus.” Under this statute, the employer may be responsible for providing an accessible living environment.

Georgia courts see vast numbers of cases filed each year. In an effort to help courts deal with the volume of cases that are filed, the legislature as well as the court system have developed certain procedural rules that must be followed in order for a case to be properly resolved. These rules come into play early in a case, starting with when, where, and how the case is filed.

In Georgia workers’ compensation cases, generally an injured worker will file a claim. If the employer denies the claim, the claim can be submitted to the State Board of Workers’ Compensation for resolution. In some situations, a party that believes the board made an incorrect decision can then appeal the case to a civil court of law. However, Georgia law only allows for a workers’ compensation appeal to be heard when there has been a “final order or judgment” entered in a case. A recent case decided by the Georgia Court of Appeals illustrates how meticulous courts can be when applying procedural rules and laws.

The Facts of the Case

A worker was injured while on the job. The employee filed for medical benefits under the workers’ compensation program, but his employer denied the benefits. Specifically, the employer claimed that the employee’s claim was not filed in a timely manner and that the statute of limitations barred the employee’s claim.

Earlier this month, a Florida appellate court issued a written opinion in a workers’ compensation case that upheld a lower court’s decision to apply the “firefighter’s presumption” to the plaintiff’s claim that he sustained coronary artery disease as a result of his employment. Ultimately, the court held that, despite some evidence that the firefighter had some risk factors of coronary artery disease, the presumption was proper. Furthermore, since the employer failed to present evidence to dispute the major contributing cause of the coronary artery disease, the employer failed to overcome the presumption.

The Effect of Presumptions in Workers’ Compensation Cases

In some situations, it is difficult or impossible for a party to obtain the evidence they would need to prove their workers’ compensation case, despite that party’s best efforts. However, out of an interest in fairness, state legislatures have enacted statutes that create presumptions that injured workers can use to help establish their case. For example, in both Florida and Georgia, a firefighter who is diagnosed with heart or lung disease is presumed to have gotten that disease through his or her on-the-job exposure.

When a presumption applies in a workers’ compensation case, the burden to disprove the presumption shifts to the employer. The employer must then submit some evidence to overcome the presumption, or the presumption will stand, and the worker’s injuries will be determined to be work-related for the purpose of a workers’ compensation claim.

Earlier this month, the Court of Appeals of Georgia issued a written opinion in a workers’ compensation case brought by a man who was injured while he was grocery shopping on his personal time. The injured employee claimed that he was a “continuous employee” because his job required that he stay in a hotel away from his home. Ultimately, the court affirmed the lower court’s decision that the injured worker was not a continuous employee.

The Facts of the Case

The injured worker was employed by a plumbing company based in Augusta, Georgia. Since the employee did not have a residence in Augusta, the employer provided the employee with a hotel room. While the employee only worked Monday through Friday, the employer allowed the employee to stay in the room over the weekend because the employee was having car trouble and found it financially burdensome to travel back home over the weekends.

One Sunday, the employee was grocery shopping when he tripped and fell, injuring his ankle. The employee was not working that day, and he was not on call. The employee filed a claim for workers’ compensation, claiming that he was a continuous employee.